JOPHON NCPD (Jan/Feb 2026) Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales, a Scoping Review-ARTICLE- JOPHON NCPD (Jan/Feb 2026) Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales, a Scoping Review

ARTICLE- JOPHON NCPD (Jan/Feb 2026) Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales, a Scoping Review

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This scoping review examined whether Pediatric Early Warning Scores (PEWS) can predict clinical deterioration and unplanned PICU transfers in pediatric hematology-oncology patients. The authors searched PubMed, CINAHL, Scopus, and Web of Science for English-language studies published from 2013 to 2023. From 3,084 records, only seven studies met inclusion criteria.<br /><br />The review found that four PEWS models were used: Bedside PEWS, Modified Bedside PEWS, Children’s Hospital Early Warning Score (CHEWS), and Modified Brighton PEWS. Overall, these tools showed good predictive performance in this high-risk population. Reported area under the ROC curve values were high, including 0.93 for Bedside PEWS, 0.95 for CHEWS, and 0.91 for Modified Brighton PEWS. Rising PEWS values within 24 hours before a critical event consistently signaled worsening condition and higher likelihood of unplanned PICU transfer.<br /><br />The scores were also associated with other important outcomes, such as early detection of minor deterioration, need for extra therapies, shorter hospital stays, and in some studies lower mortality after PEWS implementation. However, results varied across studies because of differences in patient populations, score versions, cutoff values, and study designs.<br /><br />The review concludes that PEWS are valuable tools for early recognition of deterioration in pediatric oncology and stem cell transplant patients, but no single scale can yet be considered the best option. Most available studies were retrospective and single-center, so stronger prospective, multicenter research is needed. Future work should test PEWS in diverse settings, refine them for specific oncology risks, and explore integration with electronic health records to improve timely clinical response.

Keywords

Pediatric Early Warning Scores

PEWS

pediatric hematology-oncology

clinical deterioration

unplanned PICU transfer

Bedside PEWS

CHEWS

Modified Brighton PEWS

ROC curve

early warning systems